GHANA: Race against time to cut maternal mortality

Friday, August 8, 2008

In a country where the World Health Organization estimates 560 pregnant women will die out of every 100,000 that go into labour, the news that a birth is imminent can be a distressing experience for expectant mothers and their families.

One such woman, Joanna Dartey, 38, emerged from the consulting room at Ghana’s main government hospital with thick sweat on her brow. “I am scared”, she said, after recounting the news from her doctor that she will be going into labour within the next seven days.

Dartey’s fear is even more pronounced because just one month ago she buried her elder sister who died with her unborn child whilst delivering.

“I am overwhelmed but I believe God will give me a safe delivery because I have faith in Him,” she said.

National emergency

Sub-Saharan Africa has the highest maternal mortality rates in the world with 900 deaths per 100,000 live births according to the World Health Organisation.

Ghana’s maternal mortality rate is actually one of the lowest in the region. In the hardest hit areas in the north of the country, rural communities say the rate of deaths among pregnant women is 700 deaths per 100,000 live births.

Ghana is seen as one of the richest and most developed countries in West Africa, and its officials say they feel they should have a maternal mortality rate must lower.

“For us it’s a crisis situation and it is unacceptable,” said the director-general of the Ghana Health Service Dr. Elias Sory.

“Our anxiety about the existing situation stems from our desire to meet the Millennium Development Goal (MDG) by the 2015 deadline,” Sory said, referring to MDG 5 which calls for an improvement in maternal health.

“For Ghana this means reducing maternal mortality by three quarters to 54 deaths per 100,000 births,” Sory said.

Known emergency

Maternal mortality in Ghana has already been declared a national emergency by Health Minister, Courage Kwashigah. “The paradox is that we know what is killing them,” the minister said.

In Ghana, only 35 percent of all deliveries are supervised by a qualified medical practitioner. The remaining 75 per cent of women either deliver at home or seek traditional help.

The Africa Director of the campaign group, Commonwealth Human Rights Initiative, Nana Oye Lithur says “most pregnant women cannot afford the cost of delivery, if they can, especially in the rural areas, they are faced with no health centres close by and even where there are, there are no qualified personnel.”

Recent research published by IMPACT, an international medical NGO, showed that normal deliveries cost approximately US$43 in Ghana compared to US$39 in neighbouring Burkina Faso. For a caesarian birth a Ghanaian woman will pay $229 whilst a Burkinabe will pay US$124.

“If you cannot afford you will certainly risk delivering at the hands of an unprofessional and pay a few dollars, but then you might die,” Oye Lithur says.

Grimmer and grimmer

The situation is even grimmer because there is a shortage of doctors and midwives. In Ghana there is just one trained midwife per 1,510 people and one doctor per 17,733 people.

Some 70 per cent of medical officials are based in the capital Accra and the second largest city, Kumasi. For a population of 22 million people there are only 1,439 health care facilities.

With no hospitals, no doctors or midwives and no money in their pockets, many expectant mothers will stay at home or risk bleeding to death whilst on their way to a distant health facility. “It’s not surprising that bleeding is the second leading course of maternal mortality,” said Sory.

Unsafe abortions are the fourth highest course of maternal mortality.

Nonetheless, the government has made some moves to improve the situation. Since 1 July women have been granted free access to maternal health care covering them from pregnancy through to one year after the birth.

This became possible due to a US$90 million grant from the UK government. Women are only required to sign on to the National Health Insurance Scheme to enjoy the facility and health officials say already 51,000 women across the country had registered.

The government has also set up what health officials term an “MDG 5 task force” to increase deliveries supervised by qualified health professionals to 70 per cent.

The Ghana Health Service acknowledges the urgent need for additional health facilities and more qualified health personnel especially in rural communities with the expected increase in attendance at health facilities.

Sory says intensive lobbying is underway to get a bigger health sector budget next year “as it’s now a case of a race against time to meet MDG 5.”